A Prospective Study on Clinical Profile of Autosomal Dominant Polycystic Kidney Disease (ADPKD) in Jammu for a Period of 1 Year

Ashwani Kumar, Zaffar kawoosa, Sajad Hamid, Surendar Kumar Bali, Mymoona Akhter, Shahnawaz Hamid

Department of Medicine, Government Medical College, Chandigarh, India.
Department of Medicine, Government Medical College, Srinagar, India.
Department of Medicine, SKIMS Medical College, Srinagar, India.
Government Medical College, Jammu, India.
Sher-i-Kashmir Institute of Medical Sciences, Kashmir,India.
SKIMS Medical College, Srinagar, India.

DOI: 10.4236/ojneph.2012.24020                

Abstract

The Present Study was conducted in department of Medicine, Govt. Medical College, jammu, Where a total of 41 patients—29 males and 12 females—fulfilled the inclusion criteria of ADPKD, were gathered during the period of 1 year starting from Nov. 2011 to Oct. 2012. All the patients were subjected to a detailed history, clinical examination and laboratory investigations. X-ray chest (PA view), ECG and ultrasound of abdomen for kidneys, liver and spleen were done. Intravenous pyelogram and CT scan of abdomen was done when a definitive diagnosis of (ADPKD) could not be made on abdominal ultrasound. Echocardiography was done to evaluate cardiac murmurs and associated mitral valve prolapse, based on standard criteria. Male to female patients with ADPKD was 2.42:1. Maximum 17 (41.5%) patients of both gender were seen in 30 - 40 years age group, Family history of ADPKD was present in 18 (43.9%) patients; Hypertension, alone or in combination with renal failure, was present in 65.8% patients; Hypertension alone was present in 19 (46.3%) patients;8 (19.5%) patients with hypertension had renal failure; Low back pain was present in 24 (58.5%) and abdominal pain in 22 (53.7%) patients; 15 (36.6%) patients presented with at least one episode of gross haematuria; Headache was experienced by 18 (43.9%) patients. On clinical examination, 24 (58.5%) were found to have palpable kidney and 10 (24.4%) had palpable liver. Spleen was palpable in 1 (2.4%) patient, Murmur of mitral valve prolapse was found in 2 (4.9%) Patients; 3 (7.3%) patients having left ventricular hypertrophy; mean Hb was 11.2 g/dL. The liver cysts were found in 24.4% of the patients; Out of 10 (24.4%) patients with hepatic cyst involvement, 1 patient each was found to have evidence of portal hypertension and evidence of hepatic cyst infection. In the present study, hypertension was most common presentation of this disease. So, control of hypertension is very important to prevent progression of this disease. Patients who are detected to have ADPKD should be regularly followed-up to prevent further progression by timely intervention. Also, family members of patients should be screened for disease and initiate treatment as early as possible.

Keywords

Autosomal Dominant Polycystic Kidney Disease; Ronic Kidney Disease; End-Stage Renal Disease

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	P. D. Wilson, “Polycystic Kidney Disease,” New England Journal of Medicine, Vol. 350, No. 2, 2004, pp. 151-164. doi:10.1056/NEJMra022161
[2]	F. Davies, G. A. Coles, P. S. Harper, et al., “Polycystic Kidney Disease Re-Evaluated: A Population-Based Study,” QJM: An International Journal of Medicine, Vol. 79, No. 3, 1991, pp. 477-485.
[3]	P. S. Parfrey, J. C. Bear, J. Morgan, et al., “The Diagnosis and Prognosis of Autosomal Dominant Polycystic Kidney Disease,” New England Journal of Medicine, Vol. 323, No. 16, 1990, pp. 1085-1090. doi:10.1056/NEJM199010183231601
[4]	A. C. Ong and P. C. Harris, “Molecular Pathogenesis of ADPKD: The Polycystin Complex Gets Complex,” Kidney International, Vol. 67, No. 4, 2005, pp. 1234-1247. doi:10.1111/j.1523-1755.2005.00201.x
[5]	V. E. Torres and P. C. Harris, “Autosomal Dominant Polycystic Kidney Disease,” Nefrologia, Vol. 23, Suppl. 1, 2003, pp. 14-22.
[6]	O. Ibraghimov-Beskrovnaya, W. R. Dackowski, L. Foggensteiner, et al., “Polycystin: In Vitro Synthesis, in vivo Tissue Expression, and Subcellular Localization Identifies a Large Membrane Associated Protein,” Proceedings of the National Academy of Sciences, Vol. 94, No. 12, 1997, pp. 6397-6402. doi:10.1073/pnas.94.12.6397
[7]	W. J. Kimberling, S. Kumar, P. A. Gabow, et al., “Autosomal Dominant Polycystic Kidney Disease: Localization of the Second Gene to Chromosome 4q13-q23,” Genomics, Vol. 18, No. 3, 1993, pp. 467-472. doi:10.1016/S0888-7543(11)80001-7
[8]	N. Hateboer, M. A. v Dijk, N. Bogdanova, et al., “Comparison of Phenotypes of Polycystic Kidney Disease Types 1 and 2. European PKD1-PKD2 Study Group,” Lancet, Vol. 353, No. 9147, 1999, pp. 103-107. doi:10.1016/S0140-6736(98)03495-3
[9]	P. Igarashi and S. Somlo, “Genetics and Pathogenesis of Polycystic Kidney Disease,” Journal of the American Society of Nephrology, Vol. 13, No. 9, 2002, pp. 2384-2398. doi:10.1097/01.ASN.0000028643.17901.42
[10]	D. D. Woo, S. Y. Miao, J. C. Pelayo, et al., “Taxol Inhibits Progression of Congenital Polycystic Kidney Disease,” Nature, Vol. 368, 1994, pp. 750-753. doi:10.1038/368750a0
[11]	J. Grantham, B. J. Cowley and V. E. Torres, “Progression of Autosomal Dominant Polycystic Kidney Disease (ADPKD) to Renal Failure,” In: D. Seldin and G. Giebisch, Eds., The Kidney: Physiology and Pathophysiology, Lippincott Williams and Wilkins, Philadelphia, 2000, pp. 2513-2536
[12]	Z. D. heng, M. Wolfe, B. D. Cowley Jr, et al., “Urinary Excretion of Monocyte Chemoattractant Protein-1 in Autosomal Dominant Polycystic Kidney Disease,” Journal of the American Society of Nephrology, Vol. 14, No. 10, 2003, pp. 2588-2595.
[13]	A. B. Chapman, A. Johnson, P. A. Gabow, et al., “The Re- nin-Angiotensin-Aldosterone System and Autosomal Do- minant Polycystic Kidney Disease,” New England Journal of Medicine, Vol. 323, No. 16, 1990, pp. 1091-1096. doi:10.1056/NEJM199010183231602
[14]	P. A. Gabow, I. Duley and A. M. Johnson, “Clinical Profiles of Gross Hematuria in Autosomal Dominant Polycystic Kidney Disease,” American Journal of Kidney Diseases, Vol. 20, No. 1992, pp. 140-143
[15]	E. Levine and J. J. Grantham, “Perinephric Hemorrhage in Autosomal Dominant Polycystic Kidney Disease: CT and MR Findings,” Journal of Computer Assisted Tomography, Vol. 11, No. 1, 1987, pp. 108-111. doi:10.1097/00004728-198701000-00021
[16]	Y. Ubara, et al., “Transcatheter Renal Arterial Embolization Therapy on a Patient with Polycystic Kidney Disease on Hemodialysis,” American Journal of Kidney Diseases, Vol. 34, No. 5, 1999, pp. 926-931.
[17]	A. Vijay, A. Vijay and P. Pankaj, “Autosomal Dominant Polycystic Kidney Disease: A Comprehensive Review,” International Urology and Nephrology, Vol. 2, No. 1, 2010, pp. 172-192
[18]	G. M. Fick-Brosnahan, Z. V. Tran, A. M. Johnson, et al., “Progression of Autosomal-Dominant Polycystic Kidney Disease in Children,” Kidney International, Vol. 59, No. 5, 2001, pp. 1654-1662. doi:10.1046/j.1523-1755.2001.0590051654.x
[19]	W. J. Amend, “Polycystic Kidney Disease and Seatbelts,” Annals of Internal Medicine, Vol. 79, No. 2, 1973, pp. 287-292.
[20]	A. B. Chapman and R. W. Schrier, “Pathogenesis of Hypertension in Autosomal Dominant Polycystic Kidney Disease,” Seminars in Nephrology, Vol. 11, No. 6, 1991, pp. 653-660.
[21]	G. M. Fick, A. M. Johnson and W. S. Hammond, “Causes of Death in Autosomal Dominant Polycystic Kidney Disease,” Journal of the American Society of Nephrology, Vol. 5, No. 12, 1995, pp. 2048-2056.
[22]	M. Loghman-Adham, C. E. Soto, T. Inagami, et al., “The Intrarenal Renin-Angiotensin System in Autosomal Dominant Polycystic Kidney Disease,” American Journal of Physiology—Renal Physiology, Vol. 287, No. 4, 2004, pp. 775-788. doi:10.1152/ajprenal.00370.2003
[23]	T. Nakamura, T. Sugaya, Y. Kawagoe, et al., “Candesartan Reduces Urinary Fatty Acid-Binding Protein Excretion in Patients with Autosomal Dominant Polycystic Kidney Disease,” American Journal of the Medical Sciences, Vol. 330, No. 4, 2005, pp. 161-165. doi:10.1097/00000441-200510000-00002
[24]	E. R. Ahmed, M. A. Tashkandi, S. Nahrir, et al., “Retrospective Analysis of Factors Affecting the Progression of Chronic Renal Failure in Adult Polycystic Kidney Disease,” Saudi Journal of Kidney Diseases and Transplantation, Vol. 17, No. 4, 2006, pp. 511-515.
[25]	G. Gambaro, A. Fabris, D. Puliatta, et al., “Lithiasis in Cystic Kidney Disease and Malformations of the Urinary Tract,” Urological Research, Vol. 34, No. 2, 2006, pp. 102-107. doi:10.1007/s00240-005-0019-z
[26]	V. B. Delaney, S. Adler, F. J. Bruns, et al., “Autosomal Dominant Polycystic Kidney Disease: Presentation, Complications, and Prognosis,” American Journal of Kidney Diseases, Vol. 5, No. 2, 1985, pp. 104-111.
[27]	O. Koslowe, R. Frank, B. Gauthier, et al., “Urinary Tract Infections, VUR and Autosomal Dominant Polycystic Kidney Disease,” Pediatric Nephrology, Vol. 18, No. 8, 2003, pp. 823-825. doi:10.1007/s00467-003-1211-4
[28]	H. Thomsen and J. Taysen, “Frequency of Hepatic Cysts in Adult Polycystic Kidney Disease,” Acta Medica Scandinavica, Vol. 224, No. 4, 1988, pp. 381-384. doi:10.1111/j.0954-6820.1988.tb19598.x
[29]	J. P. Grunfeld, G. Albouze, P. Jungers, et al., “Liver Changes and Complications in Adult Polycystic Kidney Disease,” In: J. F. Bach, J. Crosnier, J. L. Funck-Brentano et al., Eds., Advances in Nephrology, Year Book Medical Publishers, Chicago, 1985, pp. 1-20.
[30]	N. Gretz, M. Zeier, S. Geberth, et al., “Is Gender a Determinant for Evolution of Renal Failure? A Study in Autosomal Dominant Polycystic Kidney Disease,” American Journal of Kidney Diseases, Vol. 14, No. 3, 1989, pp. 178-183.
[31]	A. Telenti, V. Torres, J. J. Gross, et al., “Hepatic Cyst Infection in Autosomal Dominant Polycystic Kidney Disease,” Mayo Clinic Proceedings, Vol. 65, No. 7, 1990, pp. 933-942. doi:10.1016/S0025-6196(12)65154-4
[32]	F. Que, D. M. Nagorney, J. B. Gross Jr, et al., “Liver Resection and Cyst Fenestration in the Treatment of Severe Polycystic Liver Disease,” Gastroenterology, Vol. 108, No. 2, 1995, pp. 487-494. doi:10.1016/0016-5085(95)90078-0
[33]	P. A. Gabow, “Autosomal Dominant Polycystic Kidney Disease,” American Journal of Kidney Diseases, Vol. 22, No. 4, 1993, pp. 511-512.
[34]	W. Schievink, Torres, D. Piepgras, et al., “Saccular Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease,” Journal of the American Society of Nephrology, Vol. 3, No. 1, 1992, pp. 88-95.
[35]	C. Leier, Ba P. ker, J. Kilman, et al., “Cardiovascular Abnormalities Associated with Adult Polycystic Kidney Disease,” Annals of Internal Medicine, Vol. 100, No. 5, 1984, pp. 683-688.
[36]	R. Schieff, G. Zuckerman, H. Marter, et al., “Diverticular Disease in Patients with Chronic Renal Failure Due to Polycystic Kidney Disease,” Annals of Internal Medicine, Vol. 92, No. 1, 1980, pp. 202-204.
[37]	V. E. Torres, P. C. Harris and Y. Pirson, “Autosomal Dominant Polycystic Kidney Disease,” Lancet, Vol. 369, No. 9569, 2007, pp. 1287-1301. doi:10.1016/S0140-6736(07)60601-1
[38]	W. C. O’Neill, M. L. Robbin, K. T. Bae, et al., “Sonographic Assessment of the Severity and Progression of Autosomal Dominant Polycystic Kidney Disease: The Consortium of Renal Imaging Studies in Polycystic Kidney Disease (CRISP),” American Journal of Kidney Diseases, Vol. 46, No. 2005, pp. 1058-1064. doi:10.1053/j.ajkd.2005.08.026
[39]	H. S. Thomsen, P. Marckmann and V. B. Logager, “Update on Nephrogenic Systemic Fibrosis,” Magnetic Resonance Imaging Clinics of North America, Vol. 16, No. 4, 2008, pp. 551-560. doi:10.1016/j.mric.2008.07.011
[40]	A. D. Kistler, D. Poster, F. Krauer, et al., “Increases in Kidney Volume in Autosomal Dominant Polycystic Kidney Disease Can Be Detected within 6 Months,” Kidney International, Vol. 75, No. 2009, pp. 235-241. doi:10.1038/ki.2008.558
[41]	P. E. Bell, K. F. Hossack, P. A. Gabow, et al., “Hypertension in Autosomal Dominant Polycystic Kidney Disease,” Kidney International, Vol. 34, No. 1988, pp. 683-690. doi:10.1038/ki.1988.233
[42]	A. Bourquia, B. Ramdani, A. J. Jabrane, et al., “Dominant Renal Polycystic Disease,” Revue de Medecine Interne, Vol. 10, No. 4, 1989, pp. 313-318. doi:10.1016/S0248-8663(89)80028-1
[43]	F. A. Al-Muhanna, K. K. Malhotra, I. Saeed, et al., “Autosomal Dominant Polycystic Kidney Disease: Observations from a University Hospital in Saudi Arabia,” Saudi Journal of Kidney Diseases and Transplantation, Vol. 6, 1995, pp. 28-31.
[44]	Z. H. Bajwa, S. Gupta, C. A. Warfield, et al., “Pain Management in Polycystic Kidney Disease,” Kidney International, Vol. 60, No. 5, 2001, pp. 1631-1644. doi:10.1046/j.1523-1755.2001.00985.x
[45]	S. Graf, A. Schischma, K. E. Eberhardt, et al., “Intracranial Aneurysms and Dolichoectasia in Autosomal Dominant Polycystic Kidney Disease,” Nephrology Dialysis Transplantation, Vol. 17, No. 5, 2002, pp. 819-823. doi:10.1093/ndt/17.5.819
[46]	R. Schrier, K. McFann, A. Johnson, et al., “Cardiac and Renal Effects of Standard versus Rigorous Blood Pressure Control in Autosomal-Dominant Polycystic Kidney Disease: Results of a Seven-Year Prospective Randomized Study,” Journal of the American Society of Nephrology, Vol. 13, No. 7, 2002, pp. 1733-1739. doi:10.1097/01.ASN.0000018407.60002.B9
[47]	Z. H. Bajwa, K. A. Sial, A. B. Malik, et al., “Pain Patterns in Patients with Polycystic Kidney Disease,” Kidney International, Vol. 66, No. 4, 2004, pp. 1561-1569. doi:10.1111/j.1523-1755.2004.00921.x
[48]	W. Wolyniec, M. M. Jankowska, E. Krol, et al., “Current Diagnostic Evaluation of Autosomal Dominant Polycystic Kidney Disease,” Polskie Archiwum Medycyny Wewn?trznej, Vol. 118, No. 12, 2008, pp. 767-773.
[49]	P. Amico, S. Kalbermatter and D. Kiss, “Aliskiren Corrects Recurrent Hyperreninemia and Hyperaldosteronism in Autosomaldominant Polycystic Kidney Disease,” Clinical Nephrology, Vol. 72, No. 3, 2009, pp. 237-239.
[50]	K. T. Bae, C. Tao, F. Zhu, et al., “MRI-Based Kidney Volume Measurements in ADPKD: Reliability and Effect of Gadolinium Enhancement,” Clinical Journal of the American Society of Nephrology, Vol. 4, No. 4, 2009, pp. 719- 725. doi:10.2215/CJN.03750708
[51]	M. Barua, O. Cil, A. D. Paterson, et al., “Family History of Renal Disease Severity Predicts the Mutated Gene in ADPKD,” Journal of the American Society of Nephrology, Vol. 20, No. 8, 2009, pp. 1833-1838. doi:10.1681/ASN.2009020162
[52]	T. Ecder and R. W. Schrier, “Cardiovascular Abnormalities in Autosomal-Dominant Polycystic Kidney Disease,” Nature Reviews Nephrology, Vol. 5, No. 4, 2009, pp. 221-228. doi:10.1038/nrneph.2009.13
[53]	H. Hadimeri, K. Caidahl, O. Bech-Hanssen, et al., “Echo- cardiographic Findings in Kidney Transplant Patients with Autosomal Dominant Polycystic Kidney Disease,” Scan- dinavian Journal of Urology and Nephrology, Vol. 43, No. 5, 2009, pp. 416-419. doi:10.3109/00365590902972446
[54]	P. Hajj, S. Ferlicot, W. Massoud, et al., “Prevalence of Renal Cell Carcinoma in Patients with Autosomal Dominant Polycystic Kidney Disease and Chronic Renal Failure,” Urology, Vol. 74, No. 3, 2009, pp. 631-634. doi:10.1016/j.urology.2009.02.078
[55]	A. Idrizi, M. Barbullushi, E. Petrela, et al., “The Influence of Renal Manifestations to the Progression of Autosomal Dominant Polycystic Kidney Disease,” Hippokratia, Vol. 13, No. 3, 2009, pp. 161-164.
[56]	A. Ramunni, P. Brescia, Quaranta et al., “Cutaneous Microcirculation Is Impaired in Early Autosomal Dominant Polycystic Kidney Disease,” Nephron Clinical Practice, Vol. 113, No. 2, 2009, pp. c71-75doi:10.1159/000228537
[57]	M. Sallee, C. Rafat, J. R. Zahar, et al., “Cyst Infections in Patients with Autosomal Dominant Polycystic Kidney Disease,” Clinical Journal of the American Society of Nephrology, Vol. 4, No. 7, 2009, pp. 1183-1189. doi:10.2215/CJN.01870309
[58]	M. Sawicki, A. Walecka, J. Rozanski, et al., “Doppler Sonography Measurements of Renal Vascular Resistance in Autosomal-Dominant Polycystic Kidney Disease,” Medical Science Monitor, Vol. 15, No. 8, 2009, pp. 101-104.
[59]	A. Alam and R. D. Perrone, “Management of ESRD in Patients with Autosomal Dominant Polycystic Kidney Disease,” Advances in Chronic Kidney Disease, Vol. 17, No. 2, 2010, pp. 164-172. doi:10.1053/j.ackd.2009.12.006
[60]	K. T. Baeand and J. J. Grantham, “Imaging for the Prognosis of Autosomal Dominant Polycystic Kidney Disease,” Nature Reviews Nephrology, Vol. 6, No. 2, 2010, pp. 96-106. doi:10.1038/nrneph.2009.214
[61]	M. Barua and Y. Pei, “Diagnosis of Autosomal-Dominant Polycystic Kidney Disease: An Integrated Approach,” Seminars in Nephrology, Vol. 30, No. 4, 2010, pp. 356-365.
[62]	M. Y. Chang, C. M. Kuok, Y. C. Chen, et al., “Comparison of Intracerebral Hemorrhage and Subarachnoid Hemorrhage in Patients with Autosomal-Dominant Polycystic Kidney Disease,” Nephron Clinical Practice, Vol. 114, No. 2, 2010, pp. c158-164. doi:10.1159/000256568
[63]	A. B. Chapman, K. Stepniakowski and F. Rahbari-Oskoui, “Hypertension in Autosomal Dominant Polycystic Kidney Disease,” Advances in Chronic Kidney Disease, Vol. 17, No. 2, 2010, pp. 153-163. doi:10.1053/j.ackd.2010.01.001
[64]	P. C. Harris and S. Rossetti, “Determinants of Renal Disease Variability in ADPKD,” Advances in Chronic Kidney Disease, Vol. 17, No. 2, 2010, pp. 131-139. doi:10.1053/j.ackd.2009.12.004
[65]	E. Meijer, M. Rook, H. Tent, et al., “Early Renal Abnormalities in Autosomal Dominant Polycystic Kidney Disease,” Clinical Journal of the American Society of Nephrology, Vol. 5, No. 6, 2010, pp. 1091-1098. doi:10.2215/CJN.00360110
[66]	U. B. Muftiand, S. K. Nalagatla, “Nephrolithiasis in Autosomal Dominant Polycystic Kidney Disease,” Journal of Endourology, Vol. 24, No. 10, 2010, pp. 1557-1561.
[67]	Y. Pirson, “Extrarenal Manifestations of Autosomal Dominant Polycystic Kidney Disease,” Advances in Chronic Kidney Disease, Vol. 17, No. 2, 2010, pp. 173-180. doi:10.1053/j.ackd.2010.01.003
[68]	Q. Qian, “Isolated Polycystic Liver Disease,” Advances in Chronic Kidney Disease, Vol. 17, No. 2, 2010, pp. 181-189. doi:10.1053/j.ackd.2009.12.005
[69]	M. A. Rabbani, B. Ahmed and M. A. Khan, “Mycobacterium Tuberculosis Infection of a Native Polycystic Kidney Following Renal Transplantation,” Transplant Infectious Disease, Vol. 13, No. 1, 2010, pp. 44-46.
[70]	D. Zheng, L. T. Cheng, Q. F. Han, et al., “Refractory Ascites Due to Portal Hypertension in Autosomal Dominant Polycystic Kidney Disease (Adpkd) Patients Successfully Treated with Peritoneal Dialysis,” Peritoneal Dialysis International, Vol. 30, No. 2, 2010, pp. 151-155. doi:10.3747/pdi.2009.00129
[71]	K. I. Glassberg, R. E. Hackett, K. Waterhouse, “Congenital Anomalies of the Kidney, Ureter and Bladder,” In: A. R. Kendall and L. Karafin, Eds., Harry S Coldsmith’s Practice of Surgery: Urology, Harper and Row, Hagerstown, 1981.
[72]	M. A. Rabbani, A. Ahmad, S. S. Ali, et al., “Clinical Presentation and Outcome of Autosomal Dominant Polycystic Kidney Disease in Pakistan: A Single Center Experience,” Japan Pharmaceutical Manufacturers Association, Vol. 58, No. 6, 2008, pp. 305-311.
[73]	P. A. Gabow, A. B. Chapman, A. M. Johnson, et al., “Renal Structure and Hypertension in Autosomal Dominant Polycystic Kidney Disease,” Kidney International, Vol. 38, No. 6, 1990, pp. 1177-1180. doi:10.1038/ki.1990.330
[74]	J. E. Rall and H. M. Odel, “Congenital polycystic Disease of the Kidney: Review of the Literature, and Data on 207 Cases,” American Journal of the Medical Sciences, Vol. 218, No. 4, 1949, pp. 399-407. doi:10.1097/00000441-194910000-00007
[75]	O. Z. Dalgaard, “Bilateral Polycystic Disease of the Kidneys. A Follow-Up of Two Hundred and Eighty-Four Patients and Their Families,” Acta Medica Scandinavica, Vol. 328, 1957, 1-255. doi:10.3109/00365597409132130
[76]	L. Hansson, L. E. Karlander, W. Lundgren, et al., “Hypertension in Polycystic Kidney Disease,” Scandinavian Journal of Urology and Nephrology, Vol. 8, No. 3, 1974, pp. 203-205.
[77]	J. Milutinovic, P. J. Fialkow, L. Y. Agodoa, et al., “Autosomal Dominant Polycystic Kidney Disease: Symptoms and Clinical Findings,” QJM: An International Journal of Medicine, Vol. 53, No. 1984, pp. 511-522.
[78]	P. A. Gabow, D. W. Ikle and J. H. Holmes, “Polycystic Kidney Disease: Prospective Analysis of Nonazotemic Patients and Family Members,” Annals of Internal Medicine, Vol. 101, No. 101, 1984, pp. 238-247.
[79]	A. J. Segal, R. F. Spataro and Z. L. Barbaric, “Adult Polycystic Kidney Disease: A Review of 100 Cases,” Journal of Urology, Vol. 118, No. 5, 1977, pp. 711-713.
[80]	R. D. Perrone, “Extrarenal Manifestations of ADPKD,” Kidney International, Vol. 51, 1997, pp. 2022-2036. doi:10.1038/ki.1997.276
[81]	S. Klahr, J. Breyer, G. J. Beck, et al. “Dietary Protein Restriction, Blood Pressure Control, and the Progression Polycystic Kidney Disease. Modification of Diet in Renal Disease Study Group,” Journal of the American Society of Nephrology, Vol. 5, 1995, pp. 2037-2047.
[82]	M. Martinez-Maldonado, J. J. Yium, W. N. Suki, et al., “Electrolyte Excretion in Polycystic Kidney Disease: Interrelationship between Sodium, Calcium, Magnesium and Phosphate,” Journal of Laboratory and Clinical Medicine, Vol. 90, No. 6, 1977, pp. 1066-1075.
[83]	C. Montoyo, M. A. Marinez, C. Campo, et al., “Nephrotic syndrome and Focal Glomerculosclerosis in Adult Polycystic Kidney Disease,” Nephron, Vol. 61, No. 1, 1992, pp. 106-110. doi:10.1159/000186845
[84]	J. F. Reckelhoff and J. P. Granger, “Role of Andorgens in Mediating Hypertension and Renal Injury,” Clinical and Experimental Pharmacology and Physiology, Vol. 26, No. 2, 1999, pp. 127-131. doi:10.1046/j.1440-1681.1999.02996.x
[85]	R. Dedi, S. Bhandari, J. H. Turney, et al., “Lesson of the Week: Causes of Hematuria in Adult Polycystic Kidney Disease,” British Medical Journal, Vol. 323, 2001, pp. 386-387. doi:10.1136/bmj.323.7309.386
[86]	D. Chauveau, F. Fakhouri, J. P. Grünfeld, “Liver Involvement in Autosomal-Dominant Polycystic Kidney Disease: Therapeutic Dilemma,” Journal of the American Society of Nephrology, Vol. 11, No. 9, 2000, pp. 1767-75.